The Fall
“But O how fall’n! How chang’d…”—John Milton, Paradise Lost
It was almost exactly six months ago, early in the morning, when I heard a thunk from my father’s bedroom and went to investigate.
His bed was empty, but then I saw him, splayed out on the threshold between bathroom and bedroom, his head resting against the wall. He was naked from the waist down and he seemed so vulnerable, his eyes open and darting back and forth, trying to register what had happened and where he was. When I knelt beside him, his expression was blank. He didn’t seem to understand that he’d fallen. Still, it was clear he wanted to get up.
Old people fall.
According to the CDC, about one in four Americans aged 65 and older falls every year. The odds are even higher for the old-old: Adults over 80 have a fifty percent chance of falling in any given year. My dad is 90.
It’s important to note that people don’t fall just because they get older. But it is true that older adults are far more likely to have multiple risk factors for falling: Poor vision. Foot problems. A urinary tract infection. A decline in strength and muscle mass.
Many of the medications older people take can cause dizziness or affect balance. The National Council on Aging has a list, including anti-anxiety medicines, antidepressants, antihistamines, muscle relaxants and medications for blood pressure. And falls in older adults often result from a combination of causes, such as dizziness and foot problems, for example, or confusion and poor balance.
That morning at my dad’s house, I asked him to put his arms around my neck so I could pull him to his feet. But he couldn’t understand, so his hands flopped uselessly on my shoulders. Finally, after several attempts, I helped maneuver him into a sitting position, where he rested for a few minutes and then began pointing across the room. He wanted to move the six or eight feet over to the bed and use it to stand up, which seemed like a good idea. And that bit of logical reasoning was reassuring.
Before I could help, Dad scooched his way over but then, instead of trying to leverage himself up, he lay down on the floor again, exhausted. Maybe he’d never planned to try to pull himself up. I fished some clean underwear from a drawer and pulled those on him, covered him with a blanket and slipped a pillow under his head. Then I called my brother.
“Dad’s okay,” I told him, “but he fell and I’m having trouble getting him up.”
“Would it help if I came out?” Sometimes, people say exactly the right thing when you need them to. “We could be there in ten or fifteen minutes.”
When my brother and his wife arrived, they came back to the bedroom, where I was still sitting on the floor with Dad. I touched his shoulder and told him they were here, that we were going to help get him into bed.
My dad opened his eyes and looked at us. “I’m going to sleep here,” he said, closing them again, as if napping at an odd angle on the floor were normal. Later, my brother would tell me that was the moment the seriousness of the situation hit home for him.
When our attempts at persuasion failed, my brother and I half-lifted and placed Dad in his bed despite his protests. We knew he must be weak from lack of food, so my sister-in-law plied him with cinnamon toast, and we tried to get him to drink some chocolate milk.
He just wanted to sleep.
Someone made more coffee and eggs for breakfast, and I think we shared more cinnamon rolls among the three of us. Then we called the caregiving agency’s manager, who recommended we take Dad to the emergency room. But she said she’d also respect whatever we chose to do.
My brother and I didn’t think the E.R. could possibly be a good idea for our father in his current state. Right then, we couldn’t picture convincing him to get into a car, but even if we could, the hospital—the lights and noises and people, the waiting and questions and probing—seemed too daunting.
And for what, really? We couldn’t imagine anything a hospital could do for him in the moment. Instead, we called his family doctor and set up an appointment for Monday.
Then, after a while, my brother and I returned to our father’s room and sat on the bed next to him. His breathing had slowed, and he was pale, his face gaunt. We looked at each other and motioned wordlessly. We thought he might be dying.
My family had known Dad was at risk for falling—because of his dementia, because of his dwindling balance, his shuffling gait and foot problems . But, unlike 90 percent of Americans over 80, he’s not on prescription drugs. He works out regularly, and he doesn’t drink alcohol. That Monday after the fall, his checkup at the doctor’s office didn’t reveal anything obvious, and he later tested negative for a UTI. We decided not to follow up on his doctor’s recommendations that he have a CT scan or MRI; we didn’t think whatever we learned would be worth the attendant suffering.
But one of the possible diagnoses mentioned by both Dad’s doctor and a palliative care nurse continues to make the most sense to my brother and me: We believe he had a small stroke, or perhaps several.
While people with dementia are more likely to fall because their mobility and balance are affected as their brains deteriorate, dementia didn’t explain enough on its own for Dad’s sudden changes. Up until the day of his fall, my dad’s cognitive decline had been gradual. Sometimes, his abilities would take a big step down, remain on a plateau for a while, and then decline again. But they’d never plunged abruptly like this.
I was sure my father’s fall was caused by whatever had suddenly altered in his brain, rather than vice versa, because his symptoms had started earlier in the week. His condition had changed acutely from Tuesday to Wednesday: His balance was off, and he’d begun having trouble communicating. In the two days before he fell, he’d had little appetite and spent most of the day sleeping.
That’s why I was there the morning he fell.
I don’t know how long my brother and I sat at our father’s bedside without saying anything, but eventually, we began chatting quietly with each other. We noticed Dad had opened his eyes and was staring at the ceiling, so we included him from time to time, telling stories he might remember or asking him a question. He didn’t respond. Once again, his eyes were moving back and forth rapidly, and he lay there, looking up at nothing. It wasn’t nothing, exactly, because he talked about seeing something—people? animals?—on the ceiling.
Later in the day, he was able to get up and out of bed twice, but we had to help him stand, and he leaned on us heavily for support as he walked. We celebrated when he made it around his dining room and kitchen. That afternoon, I texted an update to our sister, who lives out of state:
Not making a lot of sense, although he has insisted on going two outings… Just now, when I sneezed and woke him up, he said, “There’s a mystery. Downtown—there’s a thing.”
And I was trying to understand him, and he said, “I’m not crazy—I’ll figure it out.”
(Of course, I agreed that we’d figure it out, and I get that he’s thinking of an actual place or thing and can’t find the words.) So, that’s a glimpse of the kind of word and thought issues he’s having at the moment.
In the next few days, he continued needing assistance to rise out of a chair or from bed. He could barely talk and couldn’t comprehend much of what anyone said, and he still needed support as he walked, so we borrowed a walker for him to use. We canceled his appointments and activities, and we started 24/7 care at his house.
Children and athletes actually fall more often than older adults, but statistically, it’s the old people who face higher consequences.
I’d heard the stories—hasn’t everyone? An older parent or grandparent is living on their own and doing fine, and then, somehow, they slip or trip or take a wrong step…and then everything changes. Maybe the older adult even breaks a hip and needs surgery. They check out of the hospital and straight into a nursing home, and their chances of dying within the next year rise markedly. The research supports those anecdotes:
The consequences of falls among older adults are often devastating. One-half of elderly admitted to the hospital for a fall-related injury are discharged to a long-term care institution. Recurrent falls are also a common reason for admission to long-term care institutions.
Falls that do not result in injury often begin a downward cycle of fear that leads to inactivity and decreased strength, agility, and balance. In the worst case, this can lead to loss of independence, including long-term care placement. 25%–55% of older persons fear falling, and of those who have fear, another 20–55% restricts their activities because of this fear.
Not all falls lead to injuries. In fact, I believe my father’s fall caused him no significant harm, that it was the stroke that affected him. Afterward, he had a small bump on his head, but there was no real bruising, and his doctor didn’t think the knock on his head could have caused his confusion after the accident.
In Dad’s case, the spill was apparently a symptom, not a cause.
But falls are the leading source of injuries in people over 65. A 2020 article says that falls among older adults have been increasing, and that they’re starting to reach epidemic proportions. The authors of this study, too, emphasize the likelihood that a fall may drastically change the lives of old people: “These falls can have a severe impact on the elderly as these may lead to significant morbidity and may jeopardize their independence. It may, therefore, lead to a cascade of socioeconomic and personal consequences. “
Eventually, my dad would recover almost completely. When a nurse visits his house once a month, my father asks why. “Well, you took a fall last autumn and we were pretty worried about you,” I’ll tell him.
“Let me get this straight,” he’ll say. “Who fell?”
“You did.”
“I fell?” He’ll pause, digesting the idea. He has no memory of it. For now, the walker has been shoved off to the side, and he doesn’t need help getting up. He’s once again attending music performances, swimming and going for walks. But his recovery wasn’t instantaneous. At the time, we didn’t know how much of his mental and physical abilities were going to return.
And we certainly didn’t know what a strange, wild week lay ahead of us.